NAMS MENOPAUSE CERTIFICATION
FINAL TEST 2026 QUESTIONS WITH
CORRECT ANSWERS GRADED A+
◍ secondary causes of osteoporosiswhich 3 common drugs?.
Answer: Hyperthyroidism, hyperparathyroidism, hypercalciuria, certain
drugs (eg: tamoxifen, steroids, PPIs), calcium/vitamin D deficiency, RA,
celiac disease, malabsorptive diseases such as Crohn disease, and ulcerative
colitis
◍ Median age of menopause in US women.
Answer: 52.54 y
◍ POI.
Answer: Intermittent ovarian function & insufficient estrogen levels
occurring at age <40 y
◍ which STRAW stage?menarche / early reproductive.
Answer: -5
◍ Perimenopause Menopause Transition, EarlyList the STRAW StageWhat
defines the phase?.
Answer: STRAW Stage: (Stage -2)Persistent difference of 7 days or more in
the length of consecutive cycles.
◍ Perimenopause Menopause Transition, LateList the STRAW StageWhat
defines the phase?.
Answer: STRAW Stage: (Stage -1)60 or more consecutive days of
amenorrhea
◍ Describe the E2 level during the life of a patient with obesity..
Answer: They are also more likely to have lower
, premenopause/perimenopausal estradiol levels compared to patients with
average BMIs. However, the level is the highest in postmenopausal patients
with obesity.
◍ which STRAW stage?peak reproductive.
Answer: -4
◍ In comparison to other ethnicities, Chinese and Japanese women have ___
E2 levels?.
Answer: These ethnic groups have lower estradiol levels than white, black
and hispanic women.
◍ which STRAW stage?late reproductive.
Answer: -3
◍ which STRAW stage?perimenopause.
Answer: -2 to -1 & +1a
◍ STRAW Stage +2, describe the timeline as well as the predominant
symptoms..
Answer: Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP.
Somatic aging predominates. Increased genitourinary symptoms.
◍ Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria
and the symptoms..
Answer: Postmenopause, Early. 2 years after FMP. +1a/b (2yrs) FSH
variable where as the AMH and InhB are low. The AFC are very low. VMS
predominate.1c (3-6yrs) FSH levels stabilize. The other measures continue
as previous.
◍ which STRAW stage?FMP &12 months after final menstrual period.
Answer: FMP = 012 months after = +1a
◍ Describe the phases during the early menopause transition and what happens
with PMS symptoms.
Answer: Menstrual cycle shortens. Due to unrestrained FSH, follicular phase
compresses. More premenstrual symptoms due to the longer luteal phase.
, Cycle irregularity and skipped cycles because of ovulatory failure and
increased atresia.
◍ What lab is potentially the superior marker of time to menopause?.
Answer: AMH
◍ Location of GU estrogen receptors (4).
Answer: Vagina, vulva, urethra, trigone of the bladder
◍ List the effects of estrogen on tissue (4+2).
Answer: 1 ) maintains blood flow to tissue, maintains the collagen within the
epithelium, and maintains the hyaluronic acid and mucopolysaccharides
within the moistened epithelial surface, maintains pH (4.5) 2) supports
microbiome and protects tissue from pathogens
◍ List the vaginal changes with menopause you might note on
clinical/microscopic exam..
Answer: Thinning of the epithelial layer, loss of elasticity with narrowing of
the canal and poor distention, noted on pelvic exam with loss or absence or
rugae. Due to the decrease in glycogen content, the lactobacilli are
decreased resulting in higher pH.
◍ List the vulvar and urethral changes in menopause..
Answer: Thinning of the epithelial layers and vagina narrowing leads the
urethra to move closer to the introitus.
◍ What does AFC stand for? What is considered a normal value?.
Answer: Antral Follicle Count> 12 follicles detectable with ultrasound is
considered normal
◍ What is the significance of antral follicle count?.
Answer: The ability of the ovaries to respond. It can represent the number of
follicles detectable with ultrasound. It is sensitive to FSH, and represents the
available pool of follicles.
◍ What is the FSH level on a random draw in Late menopause transition
(STRAW Stage: -1)?.
, Answer: 25 IU/L or higher
◍ What happens to SHBG during menopause? How does that effect the free
androgen index?.
Answer: SHBG decreases. Testosterone/SHBG ratio increases by 80%.
◍ Testosterone:SHGB ratio is called what?.
Answer: The free androgen index
◍ which STRAW stage?VMS most likely.
Answer: +1a (most likely)-1 (likely)aka perimenopause/menopause
transition
◍ Driving piece of menopause is ovarian follicles depleting. What does this do
to the inhibin B and AMH? What does that do to FSH?.
Answer: Inhibin B and AMH decrease.Decreased InhB leads to unrestrained
FSH. This allows for the growth of the remaining, diminished follicle pool
(shortened follicular phase). Increased atresia. Occasional LOOP cycles.
◍ What are considered the 'adrenal androgens'?.
Answer: Precursor hormones produced by the adrenal gland, which are
enzymatically converted to active androgens/estrogens in peripheral
tissue.Dehydroepiandrosterone DHEADehydroepiandrosterone-sulfate
DHEASAndrostenedioneTestosterone
◍ Aldosterone secretion from the zona glomerulosa in the adrenal gland is
regulated by 3 main factors:.
Answer: Angiotensin II (RAAS), Potassium Concentration, ACTH secreted
by the anterior pituitary.
◍ which STRAW stage?early post menopause.
Answer: +1a to +1c
◍ which STRAW stage?late postmenopause.
Answer: +2
◍ which STRAW stage?amenorrhea >60 days.
Answer: -1aka late menopause transition
FINAL TEST 2026 QUESTIONS WITH
CORRECT ANSWERS GRADED A+
◍ secondary causes of osteoporosiswhich 3 common drugs?.
Answer: Hyperthyroidism, hyperparathyroidism, hypercalciuria, certain
drugs (eg: tamoxifen, steroids, PPIs), calcium/vitamin D deficiency, RA,
celiac disease, malabsorptive diseases such as Crohn disease, and ulcerative
colitis
◍ Median age of menopause in US women.
Answer: 52.54 y
◍ POI.
Answer: Intermittent ovarian function & insufficient estrogen levels
occurring at age <40 y
◍ which STRAW stage?menarche / early reproductive.
Answer: -5
◍ Perimenopause Menopause Transition, EarlyList the STRAW StageWhat
defines the phase?.
Answer: STRAW Stage: (Stage -2)Persistent difference of 7 days or more in
the length of consecutive cycles.
◍ Perimenopause Menopause Transition, LateList the STRAW StageWhat
defines the phase?.
Answer: STRAW Stage: (Stage -1)60 or more consecutive days of
amenorrhea
◍ Describe the E2 level during the life of a patient with obesity..
Answer: They are also more likely to have lower
, premenopause/perimenopausal estradiol levels compared to patients with
average BMIs. However, the level is the highest in postmenopausal patients
with obesity.
◍ which STRAW stage?peak reproductive.
Answer: -4
◍ In comparison to other ethnicities, Chinese and Japanese women have ___
E2 levels?.
Answer: These ethnic groups have lower estradiol levels than white, black
and hispanic women.
◍ which STRAW stage?late reproductive.
Answer: -3
◍ which STRAW stage?perimenopause.
Answer: -2 to -1 & +1a
◍ STRAW Stage +2, describe the timeline as well as the predominant
symptoms..
Answer: Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP.
Somatic aging predominates. Increased genitourinary symptoms.
◍ Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria
and the symptoms..
Answer: Postmenopause, Early. 2 years after FMP. +1a/b (2yrs) FSH
variable where as the AMH and InhB are low. The AFC are very low. VMS
predominate.1c (3-6yrs) FSH levels stabilize. The other measures continue
as previous.
◍ which STRAW stage?FMP &12 months after final menstrual period.
Answer: FMP = 012 months after = +1a
◍ Describe the phases during the early menopause transition and what happens
with PMS symptoms.
Answer: Menstrual cycle shortens. Due to unrestrained FSH, follicular phase
compresses. More premenstrual symptoms due to the longer luteal phase.
, Cycle irregularity and skipped cycles because of ovulatory failure and
increased atresia.
◍ What lab is potentially the superior marker of time to menopause?.
Answer: AMH
◍ Location of GU estrogen receptors (4).
Answer: Vagina, vulva, urethra, trigone of the bladder
◍ List the effects of estrogen on tissue (4+2).
Answer: 1 ) maintains blood flow to tissue, maintains the collagen within the
epithelium, and maintains the hyaluronic acid and mucopolysaccharides
within the moistened epithelial surface, maintains pH (4.5) 2) supports
microbiome and protects tissue from pathogens
◍ List the vaginal changes with menopause you might note on
clinical/microscopic exam..
Answer: Thinning of the epithelial layer, loss of elasticity with narrowing of
the canal and poor distention, noted on pelvic exam with loss or absence or
rugae. Due to the decrease in glycogen content, the lactobacilli are
decreased resulting in higher pH.
◍ List the vulvar and urethral changes in menopause..
Answer: Thinning of the epithelial layers and vagina narrowing leads the
urethra to move closer to the introitus.
◍ What does AFC stand for? What is considered a normal value?.
Answer: Antral Follicle Count> 12 follicles detectable with ultrasound is
considered normal
◍ What is the significance of antral follicle count?.
Answer: The ability of the ovaries to respond. It can represent the number of
follicles detectable with ultrasound. It is sensitive to FSH, and represents the
available pool of follicles.
◍ What is the FSH level on a random draw in Late menopause transition
(STRAW Stage: -1)?.
, Answer: 25 IU/L or higher
◍ What happens to SHBG during menopause? How does that effect the free
androgen index?.
Answer: SHBG decreases. Testosterone/SHBG ratio increases by 80%.
◍ Testosterone:SHGB ratio is called what?.
Answer: The free androgen index
◍ which STRAW stage?VMS most likely.
Answer: +1a (most likely)-1 (likely)aka perimenopause/menopause
transition
◍ Driving piece of menopause is ovarian follicles depleting. What does this do
to the inhibin B and AMH? What does that do to FSH?.
Answer: Inhibin B and AMH decrease.Decreased InhB leads to unrestrained
FSH. This allows for the growth of the remaining, diminished follicle pool
(shortened follicular phase). Increased atresia. Occasional LOOP cycles.
◍ What are considered the 'adrenal androgens'?.
Answer: Precursor hormones produced by the adrenal gland, which are
enzymatically converted to active androgens/estrogens in peripheral
tissue.Dehydroepiandrosterone DHEADehydroepiandrosterone-sulfate
DHEASAndrostenedioneTestosterone
◍ Aldosterone secretion from the zona glomerulosa in the adrenal gland is
regulated by 3 main factors:.
Answer: Angiotensin II (RAAS), Potassium Concentration, ACTH secreted
by the anterior pituitary.
◍ which STRAW stage?early post menopause.
Answer: +1a to +1c
◍ which STRAW stage?late postmenopause.
Answer: +2
◍ which STRAW stage?amenorrhea >60 days.
Answer: -1aka late menopause transition
